Arthroscopy of the Dorsal and Plantar Pouches of the Tarsocrural Joint for the Treatment of Osteochondritis Dissecans in the Horse: Clinical Features and Follow-Up.

OBJECTIVE: To describe the clinical details and pathology within the dorsal and plantar pouches of the tarsocrural joint of a population of horses that underwent arthroscopic surgery for tarsocrural osteochondritis dissecans (OCD). STUDY DESIGN: Retrospective cohort study. ANIMALS: Horses referred for arthroscopic treatment of tarsocrural OCD between 2005 and 2013 (102 horses; 144 joints). METHODS: Case records of all horses that had tarsocrural arthroscopy for OCD at Rossdales Equine Hospital, Newmarket, United Kingdom were included. Cases from 3 ECVS Diplomates were included, 1 of whom routinely examined 70 plantar pouches concurrently with routine dorsal pouch investigation. A structured questionnaire was used to obtain follow-up data alongside examination of racing records where appropriate. Descriptive data and 95% CI were calculated. RESULTS: Of the 70 joints that had both dorsal and plantar pouches examined, there was cartilage erosion/degeneration in 22 dorsal pouches (31.4%), cartilage wear lines in 32 plantar pouches (45.7%), and fragments were removed at the time of surgery from 7 plantar pouches (10.0%). Of the plantar pouches with wear lines, 18 (25.7%) had no evidence of cartilage abnormalities (separate from the OCD lesion) within the dorsal pouch. From the 102 horses with available follow-up, 34 horses (66.7%) achieved their intended use postsurgery. CONCLUSION: Routine plantar pouch investigation is warranted in cases of tarsocrural OCD to provide further information on the health of the joint and allows for removal of fragments from the plantar pouch that may not have been identified by routine diagnostic radiography.

Locking Compression Plate Fixation of Equine Tarsal Subluxations.

OBJECTIVE: To report the clinical findings and outcome of locking compression plate (LCP) fixation of tarsal subluxations in horses. STUDY DESIGN: Retrospective case series. ANIMALS: Horses (n = 3) and ponies (2). METHODS: All horses and ponies diagnosed with tarsal subluxations and treated with LCP fixation at our institution between 2011 and 2013 were included. Data were collected from the medical records, including all radiographic and computed tomographic (CT) studies and reviewed. Long-term (>1 year) followup examination, including owner interview, and clinical and radiographic examinations were performed for all cases. RESULTS: Subluxations of the tarsometatarsal (n = 3) and proximal intertarsal (2) joints were diagnosed. CT examinations revealed complex joint injuries, including a combination of avulsion fragments and compression injuries at the opposite side of the joint from the subluxation. The LCP was applied to the plantarolateral or medial side of the limb. All horses survived and were discharged from the hospital. Short-term complications included mild laminitis (n = 1) and peroneus tertius rupture (2). At long-term followup, both ponies were sound and used as intended, whereas all horses showed mild to moderate lameness at the trot and were used for pleasure riding only. Radiographic signs of osteoarthritis developed in the joint affected by subluxation in all cases and in adjacent small tarsal joints in 2 horses and 1 pony. CONCLUSION: LCP fixation of tarsal subluxations resulted in stable fixation and allowed adequate healing. Subluxation of the small tarsal joints represents a complex injury and osteoarthritis commonly develops in the affected and adjacent joints.

A rare presentation of foot pain: bilateral navicular-medial cuneiform coalition.

In this case report, we discuss a rare tarsal coalition occurring bilaterally between the navicular and the medial cuneiform in a 15-year-old girl and highlight the management of such cases.

Screw size and insertion technique compared with removal rates for calcaneal displacement osteotomies.

BACKGROUND: The calcaneal displacement osteotomy is frequently used by foot and ankle surgeons to correct hindfoot angular deformity. Headed compression screws are often used for this purpose, but a common complication is postoperative plantar heel pain from prominent hardware. We evaluated hardware removal rates after calcaneal displacement osteotomies and analyzed technical factors including screw size, position, and angle. We hypothesized that larger screws placed more plantarly would have been removed more frequently. We also believed that although 2 smaller screws cost more initially, when removal rates and cost are accounted for, savings would be demonstrated with this technique. METHODS: We retrospectively collected data on type of fixation, cost of fixation, and frequency of removal. After exclusions we had 30 patients in our screw removal cohort and 119 in our screws retained cohort. A basic cost analysis and statistical analysis was performed. RESULTS: The small screw group had a hardware removal rate of 9% (4/43) compared to 25% (26/104) of the larger screw group (P = .032). While the cost of 2 smaller screws is more than that of 1 larger screw, when the cost of removal and the rates of doing so are considered, the smaller screws resulted in substantial cost savings. CONCLUSION: Technical considerations for the medial displacement calcaneal osteotomy, including the use of multiple smaller screws, provided for a lower rate of hardware removal and likely decreased long-term costs. LEVEL OF EVIDENCE: Level III, comparative series.

The surgical treatment of children with congenital convex foot (vertical talus): evaluation of midtarsal surgical release and open reduction.

In this study we evaluated the results of midtarsal release and open reduction for the treatment of children with convex congenital foot (CCF) (vertical talus) and compared them with the published results of peritalar release. Between 1977 and 2009, a total of 22 children (31 feet) underwent this procedure. In 15 children (48%) the CCF was isolated and in the remainder it was not (seven with arthrogryposis, two with spinal dysraphism, one with a polymalformative syndrome and six with an undefined neurological disorder). Pre-operatively, the mean tibiotalar angle was 150.2° (106° to 175°) and the mean calcaneal pitch angle was -19.3° (-72° to 4°). The procedure included talonavicular and calcaneocuboid joint capsulotomies, lengthening of tendons of tibialis anterior and the extensors of the toes, allowing reduction of the midtarsal joints. Lengthening of the Achilles tendon was necessary in 23 feet (74%). The mean follow-up was 11 years (2 to 21). The results, as assessed by the Adelaar score, were good in 24 feet (77.4%), fair in six (19.3%) and poor in one foot (3.3%), with no difference between those with isolated CCF and those without. The mean American Orthopaedic Foot and Ankle Society midfoot score was 89.9 (54 to 100) and 77.8 (36 to 93) for those with isolated CCF and those without, respectively. At the final follow-up, the mean tibiotalar (120°; 90 to 152) and calcaneal pitch angles (4°; -13 to 22) had improved significantly (p < 0.0001). Dislocation of the talonavicular and calcaneocuboid joints was completely reduced in 22 (70.9%) and 29 (93.6%) of feet, respectively. Three children (five feet) underwent further surgery at a mean of 8.5 years post-operatively, three with pes planovalgus and two in whom the deformity had been undercorrected. No child developed avascular necrosis of the talus. Midtarsal joint release and open reduction is a satisfactory procedure, which may provide better results than peritalar release. Complications include the development of pes planovalgus and persistent dorsal subluxation of the talonavicular joint.

Bilateral congenital vertical talus with severe lower extremity external rotational deformity: treated by reverse Ponseti technique.

Congenital vertical talus, also known as congenital convex pes valgus, is a complex, rare, foot deformity that is resistant to conservative treatment. We report a case of bilateral congenital vertical talus with severe lower extremity external rotational deformity that was treated by means of a method of serial manipulations and casts. Although the initial manipulation and casting before surgical treatment is the current concept of idiopathic congenital vertical talus, a good result can be obtained by a well-organized conservative treatment with the help of patient compliance, so routine surgical release of the Achilles tendon may not be necessary in all cases.

Treatment of tarsal joint deformities with hinged transarticular external fixators in three young birds.

Pelvic limb deformities are common in many avian species. Three young birds, including a six-week-old Cockatoo and two three-month-old goslings, were presented with tarsal joint deformities. They were treated with an experimental prototype of a hinged linear external fixator, placed in a transarticular fashion, in order to maintain joint function during treatment. All birds had close to normal leg function at six to ten weeks postoperatively. These results suggest that the hinged external fixator may be a viable treatment option for tarsal joint deformities in young birds.

Partial tarsal arthrodesis and botulinum toxin A injection for correction of tarsal arthrogryposis in a cat.

An 11-week-old, domestic shorthair cat was presented for evaluation of a congenital right tarsal deformity. The cat was non-weightbearing lame on the right hindlimb. There was severe tarsal hyperextension and concurrent spasticity/contracture/shortening of the gastrocnemius muscle-tendon. The cat was otherwise healthy. Radiographically there was luxation of the proximal intertarsal joint and talocrural hyperextension. Treatment with 10 mu/kg botulinum toxin A (Botox; Allergan) intramuscular injections directly into the gastrocnemius muscle and passive physiotherapy marginally improved the range of motion in the talocrural joint. Definitive surgical treatment with partial tarsal arthodesis produced an excellent clinical outcome. This case report demonstrates the successful treatment of a severe congenital tarsal abnormality and also documents the first clinical use of botulinum toxin in a feline patient.

The effect of the tarsal joint positions on the tibial nerve motor action potential latency in dog: electrophysiological and anatomical studies.

This study has been carried out to determine the effect of neutral position, hyperextension and hyperflexion of the tarsal joint on the tibial nerve, motor action potential latency and tarsal canal compartment pressure in dogs with the aid of electrophysiological and anatomical methods. Totally twenty healthy mongrel dogs were used. Latency of motor nerve action potential (MNAPL) studies of tibial nerve via surface stimulating and needle recording electrodes was performed on right hind limbs of all the dogs. The compartment pressures of the tarsal canal with the pressure transducer were determined from both limbs from ten of the dogs. In one dog, tarsal regions of both left and right limbs were demonstrated using magnetic resonance imaging (MRI). Two dogs were euthanatized and tarsal regions of the dogs were sectioned for correlative anatomy. Nerve conduction studies showed that the MNAP latency of the tibial nerve were 3.55 +/- 0.097 ms, 3.76 +/- 0.087 ms and 3.39 +/- 0.097 ms in neutral, hyperextension and hyperflexion positions, respectively. Hyperflexion of the tarsal joint caused prolongation of the MNAP latency of the tibial nerve with the highest pressure value being determined in tarsal canal. From the anatomical viewpoint, the distance between the flexor hallucis longus muscle and the superficial digital muscle was the shortest during hyperflexion and the plantar branch of saphenous artery, lateral and medial plantar nerves located more laterally in cadaver and MR imaging sections. As a result of this study, it is thought that tarsal region diseases as well as long time splint in the hyperflexion position as applied in the Ehmer sling can affect the compartment pressure and nerve tension because of occupying in the tarsal canal. Raising pressure and nerve stretching in the tarsal canal compartment could cause deficiencies in the conduction velocity of the tibial nerve. This might be a result of tarsal tunnel syndrome in the dog. Clinicians could consider this syndrome in cases of tarsal region diseases as well as application of long time splint in hyperflexion of tarsal joints in dogs.

[Arthrodesis of the talonavicular joint]. / Arthrodese des Talonavikulargelenks.

The talonavicular joint as part of the coxa pedis plays a pivotal role in the overall motion of the foot. The necessity for talonavicular fusion arises from isolated arthritis of posttraumatic, rheumatoid, degenerative, or idiopathic etiology. Posttraumatic arthritis is seen after malunited mid-tarsal (Chopart) fracture-dislocations and is frequently accompanied by malalignment due to an imbalance between the medial and lateral columns of the foot. In these cases a corrective arthrodesis becomes necessary. In cases of poor bone stock or arthritis of the calcaneocuboid joint, a double arthrodesis is preferred over isolated talonavicular fusion. Fusion with mini-plates is biomechanically superior to fusion with screws and especially staples, the latter being associated with non-union rates of up to 37%. Talonavicular fusion allows reproducible pain reduction in isolated arthritis with subjective patient satisfaction of between 86% and 100% in a literature review. The substantial reduction of movement in the triple joint complex leads to overload of the adjacent joints with development of arthritis in about 30% in the medium term.

[Hyperextension of fetlock joints in German Holstein and German Holstein-Limousin crossbred calves]. / Hyperextension der Fesselgelenke bei Deutschen Holstein-Rindern und bei Deutschen Holstein-Limousin-Kreuzungskälbern.

In two different dairy farms six calves exhibiting bilateral flexion of the fetlock joints in front or rear legs were born in 2000 to 2002. Four of the affected calves from the same farm were crossbred between German Holstein cows with red and white coat colour and a bull of the breed Limousin. The other two affected calves born on another farm were purebred German Holsteins with a black and white coat colour. The tests for BVD virus antigen and antibodies were negative in all affected calves. Three of the calves showed a lower selen and a higher glutamate dehydrogenase concentration in the analyses of blood metabolites. Two crossbred calves showed a degeneration of the liver with a progressive periportal fibrosis in a histological examination. In one calf an edema of astrocytes of the central nervous system was seen. The analysis of the pedigrees revealed for the four crossbred calves the Limousin bull as common ancestor and the mothers of the calves as relatives. For the affected purebred German Holstein calves also a sire was identified as a common ancestor. The pedigrees support inheritance through a monogenic autosomal recessive locus or more recessive gene loci with variable expressivity. However, the analysis could not clarify whether different gene loci are responsible for the congenital anomalies observed in the calves from the two farms and thus, the observed anomalies may be different genetic entities. Obvious environmental reasons were not found.

High prevalence of tarsal coalitions and tarsal joint variants in a recent cadaver sample and its possible significance.

Tarsal coalitions (TC) are defined as fibrous (beyond normal ligaments), cartilaginous, or osseous unions of at least two tarsal bones. Most of the clinical studies report the prevalence of TC as <1%, but they disregard the asymptomatic coalitions. Because TC have been associated with pathologic conditions, including degenerative arthritic changes, knowledge of their prevalence has clinical importance. The aim of our study was to establish the prevalence of TC and tarsal joint variants. A total of 114 feet from 62 cadavers (average age = 78 years) without obvious foot pathologies were dissected at the Department of Anatomical Sciences, The University of Adelaide. Ten non-osseous TC in eight subjects were identified: two talocalcaneal and eight calcaneonavicular (occurred twice bilaterally). Variant calcaneonavicular and cuboideonavicular joints were found in 8% and 31% of feet, respectively. Other joint variants included a variable number of talocalcaneal joint surfaces and sesamoid bones. No secondary TC (due to trauma, infections, or neoplasm) were found. Our study demonstrated that the overall prevalence of TC is higher (13%) than previously thought; tarsal joint variations (39%) and sesamoid bones (42%) were common as well. The supposed secular increase in the prevalence of TC as well as the high number of anatomical variants could reflect a short-term response to altered life-style or a microevolutionary trend due to relaxed selection.

Coaliciones tarsianas / Tarsal coalitions: CT and MRI findings

Propósito. La coalición tarsiana es una alteración congénita infrecuente, que representa la fusión anormal entre dos o más huesos tarsianos. El propósito de ésta presentación es relatar nuestra experiencia en TC y RM de ésta patología articular, contribuyendo a difundir su diagnóstico, en muchas ocasiones pasado por alto. Se realiza más frecuentemente como hallazgo al efectuar un examen de la región tarsal por otra indicación, que como confirmación de un diagnóstico clínico presuntivo. Material y método. Entre enero de 1999 a mayo de 2001, se estudiaron 16 casos de coaliciones tarsianas, mediante TC y/o RM. Se emplearon un tomógrafo helicoidal Toshiba K-press, un tomógrafo TCT 60-X convencional (realizando algoritmos de reconstrucción con filtro óseo, con cortes de 2 mm de espesor cada 2 mm de desplazamiento de la camilla) y un resonador Toshiba Visart de 1.5 Tesla (realizando secuencias en planos axial, sagital y coronal, ponderando las secuencias T1, T2 y T2 con supresión grasa). Resultados. En los 16 casos evaluados se registraron 28 coaliciones tarsianas. Ocho pacientes presentaron coaliciones bilaterales (50 por ciento) y de los 8 restantes unilaterales, 4 poseían 4 coaliciones coexistentes (25 por ciento). Se detectaron 8 barras óseas (28,5 por ciento) y 20 no osificadas-cartilaginosas y/o fibrosas-(71,5 por ciento), correspondiendo 14 de ellas (50 por ciento) a coaliciones astragalocalcáneas, 8 (28,5 por ciento) a coaliciones calcaneoescafoideas, 4 (14,2 por ciento) a coaliciones astragaloescafoideas y 2 (7,1 por ciento) a coaliciones escafocuboideas. Conclusión. Las coaliciones calcáneoescafoideas y astragalocalcáneas comprenden aproximadamente el 80 por ciento de los casos. La radiología convencional suele ser el método de estudio inicial de ésta entidad y permite a menudo realizar el diagnóstico sin necesidad de exámenes complementarios de mayor complejidad. Cuando los hallazgos radiográficos son nulos o equívocos, es necesario recurrir a la TC o RM para arribar a un diagnóstico concluyente, diferenciar entre los subtipos y determinar el nivel de compromiso articular, lo cual es vital para definir el tratamiento

Coaliciones tarsianas / Tarsal coalitions: CT and MRI findings

Propósito. La coalición tarsiana es una alteración congénita infrecuente, que representa la fusión anormal entre dos o más huesos tarsianos. El propósito de ésta presentación es relatar nuestra experiencia en TC y RM de ésta patología articular, contribuyendo a difundir su diagnóstico, en muchas ocasiones pasado por alto. Se realiza más frecuentemente como hallazgo al efectuar un examen de la región tarsal por otra indicación, que como confirmación de un diagnóstico clínico presuntivo. Material y método. Entre enero de 1999 a mayo de 2001, se estudiaron 16 casos de coaliciones tarsianas, mediante TC y/o RM. Se emplearon un tomógrafo helicoidal Toshiba K-press, un tomógrafo TCT 60-X convencional (realizando algoritmos de reconstrucción con filtro óseo, con cortes de 2 mm de espesor cada 2 mm de desplazamiento de la camilla) y un resonador Toshiba Visart de 1.5 Tesla (realizando secuencias en planos axial, sagital y coronal, ponderando las secuencias T1, T2 y T2 con supresión grasa). Resultados. En los 16 casos evaluados se registraron 28 coaliciones tarsianas. Ocho pacientes presentaron coaliciones bilaterales (50 por ciento) y de los 8 restantes unilaterales, 4 poseían 4 coaliciones coexistentes (25 por ciento). Se detectaron 8 barras óseas (28,5 por ciento) y 20 no osificadas-cartilaginosas y/o fibrosas-(71,5 por ciento), correspondiendo 14 de ellas (50 por ciento) a coaliciones astragalocalcáneas, 8 (28,5 por ciento) a coaliciones calcaneoescafoideas, 4 (14,2 por ciento) a coaliciones astragaloescafoideas y 2 (7,1 por ciento) a coaliciones escafocuboideas. Conclusión. Las coaliciones calcáneoescafoideas y astragalocalcáneas comprenden aproximadamente el 80 por ciento de los casos. La radiología convencional suele ser el método de estudio inicial de ésta entidad y permite a menudo realizar el diagnóstico sin necesidad de exámenes complementarios de mayor complejidad. Cuando los hallazgos radiográficos son nulos o equívocos, es necesario recurrir a la TC o RM para arribar a un diagnóstico concluyente, diferenciar entre los subtipos y determinar el nivel de compromiso articular, lo cual es vital para definir el tratamiento (AU)

Tarsal coalition in adults.

32 feet in 27 adults, seen at The Johns Hopkins Hospital Foot and Ankle Clinic from 1993-1998, with the diagnosis of tarsal coalition were retrospectively reviewed. There were 18 subtalar coalitions, 14 calcaneonavicular coalitions and 1 naviculocuneiform coalition. The average age was 40 years. Clinically, 22 feet had a neutral heel, 7 had a valgus heel with flattening of the longitudinal arch, 1 had a varus heel and 2 heels had an unknown position. Subtalar motion was decreased in 23 feet. Peroneal spasm was only seen in 2 patients. 11 feet were asymptomatic. Nonoperative treatment consisting of activity modification, nonsteroidal anti-inflammatory medications and casting was successful in the majority of patients. Subtalar fusion was performed in 4 feet and coalition resection in 1. The treatment of a symptomatic tarsal coalition in the adult is as in children but the clinical presentation may differ.

An accessory ossification centre in the calcaneus with talonavicular and second metatarsocuneiform coalitions.

We present the case of an 11-year-old girl with an accessory ossification centre of the calcaneus with talonavicular and second metatarsocuneiform coalitions, and bilateral os tibiale externum.

Biofeedback eletromiografico na recuperacao do pe caido / Electromyographic biofeedback in recuperation of the foot-drop

Este resumo demonstra a utilizacao do biofeedback eletromiografico como tecnica adjunta na reabilitacao, suas indicacoes, efeitos e outros aspectos importantes a serem considerados nesta abordagem. Sequencialmente, relata um caso de pe caido por doenca cerebrovascular e polineuropatia periferica tratado com biofeedbeck eletromiografico. Os resultados indicaram ganhos significativos que repercutiram funcionalmente nas atividades de vida diaria do paciente